Osteotomy as an Alternative to Joint Replacement in Young Patients

Too Early for a Prosthesis? Preserving the Natural Joint Is Possible

In young and active individuals with cartilage loss and joint misalignment—especially in the knee or hip—the recommendation is often, “It’s too early for a prosthesis.” For these patients, one of the most effective joint-preserving surgical options is osteotomy. When joint damage is limited to one area, an osteotomy can reduce pain, delay the need for joint replacement, and help patients maintain an active lifestyle for many years.

In this article, we explore why osteotomy is an ideal option for young patients with early joint degeneration, when it is indicated, and how it helps maintain long-term joint health and function.

What Is Osteotomy?

Osteotomy is a surgical procedure in which a bone—usually the tibia, femur, or pelvis—is cut and realigned to redistribute weight away from the damaged portion of the joint. By changing the mechanical load path, the healthy cartilage takes on more of the pressure, reducing pain and slowing degeneration.

Common examples include:

• High Tibial Osteotomy (HTO) – for medial (inner) knee arthritis
• Distal Femoral Osteotomy – for lateral (outer) knee overload
• Periacetabular Osteotomy (PAO) – for hip dysplasia in young patients

The goal is to preserve the natural joint and prevent or delay prosthetic surgery.

Why Is It Preferred in Young Patients?

In younger patients, joint degeneration is often localized and mechanical in nature. These individuals are typically physically active, involved in sports or demanding professions, and eager to avoid joint replacement at an early age.

With osteotomy:

• The native joint is preserved
• Bone and soft tissue integrity remain intact
• Return to sport and work is feasible
• If needed, a future joint replacement can be performed on stronger bone

This makes osteotomy a proactive and protective approach to long-term joint health.

When Is Osteotomy Indicated?

Osteotomy may be recommended in the following situations:

• Unicompartmental osteoarthritis in the knee or hip
• Varus (bow-legged) or valgus (knock-knee) deformities
• Hip dysplasia with structural instability
• Post-injury mechanical axis deviation in athletes
• As an adjunct to meniscus or cartilage repair to offload damaged zones

Patients should have preserved range of motion, sufficient bone quality, and be motivated to adhere to the recovery and rehab protocol.

How Does the Procedure Work?

Before surgery, full-length standing X-rays or 3D imaging is used to calculate the precise correction needed. During surgery:

• A controlled bone cut is made at a calculated location
• The bone is realigned to shift weight away from the damaged joint area
• The corrected position is fixed using a plate and screws, with or without bone graft
• Bone healing typically takes 6–12 weeks

Rehabilitation begins shortly after surgery, focusing on muscle strength, range of motion, and gradual return to activity.

What Are the Advantages?

Osteotomy offers several key benefits for younger patients:

• Preserves the natural joint structure
• Delays or avoids the need for total joint replacement
• Supports a return to sport and active lifestyle
• Does not interfere with future prosthetic surgery if needed
• May prevent joint degeneration from progressing further

Rather than replacing the joint, osteotomy seeks to protect and extend its lifespan.

Realistic Expectations Are Important

While osteotomy can significantly reduce pain and improve function, it’s important to understand that:

• Bone healing takes time—usually a few months
• Weight-bearing is gradually reintroduced after surgery
• Full recovery may require 3 to 6 months
• The goal is pain relief and joint preservation—not complete elimination of symptoms

Proper rehabilitation and compliance are crucial for success.